Areas of Expertise

Claims

Nolan can successfully change the quality, cost and speed of claims services delivered by your health plan to your customers. We have decades of experience in eliminating claims backlogs. We do it so that the backlog doesn't develop again. We also have deep practical experience in helping companies to outsource claims processing. When claims service matters, Nolan delivers.

New Case Set Up

Nolan offers pragmatic solutions for problems that arise whenever new groups are added to your health plan. From underwriting to getting the group correctly configured in your system. From accurately and rapidly getting members in place to producing and mailing member ID cards to the right address. From preparing customer service representatives to taking calls and delivering new levels of service. When nothing gets done until a customer pays, Nolan delivers.

Member Service

Nolan professionals offer insight, skills and experience in making a Member Services Operation a strategic advantage in the marketplace. Most health plans have classic Member Service problems, such as unacceptable phone abandon rates, wrong answers being given to members and providers, lack of coordination between Member Services and the rest of the plan, seasonal surges in call volumes, ID card issue problems and the inability to move Member Services from an apology role to a true service role. When serving members is your first priority, Nolan delivers.

Eligibility Data Quality

Nolan has proven, effective ways of finding and correcting problems associated with eligibility data and its use across your health plan. Eligibility errors can impact any of the seven key processes your plan uses to create and deliver service to providers, members and employers. In our experience, most plans attempt to solve these problems in the processes that use eligibility data rather than at the real source of the problem. When you don't know who's in and who's out, Nolan delivers.

Provider Data Quality

Nolan can diagnose and solve complex problems involving data quality. We know that one of the most perplexing sources of complex problems in health plans is low quality provider data. These problems are hidden in your computer system -- invisible to inexperienced managers and novice consultants. These hidden problems cause a bewildering array of apparently unrelated service failures. If you have medical profiling reports that don't make sense, problems with referrals and authorizations, poor claims accuracy and troubling swings in your medical loss ratio, the root cause of these problems may lie in the quality of the provider-related data rather than problem service processes. Fixing the wrong problem will not create the improvement you need. When you need to improve the quality of your provider data, Nolan delivers.

Referral and Authorizations

Nolan redesigns and simplifies the referral and authorization process that the medical community sees as an immediate service improvement. Many plans have utilization management processes that don't contribute to controlling the medical loss ratio. Many of these same plans find that these processes are a major cost element and a source of service frustration to their providers. We have simple and effective ways of helping your staff to improve your financial and service performance. When both relations with your providers and the medical loss ratio matter, Nolan delivers.

Recovery of Funds

Nolan can eliminate the causes of overpayment, and we can design a provider-friendly recovery program. We know that health plans over-pay thousands of claims each year, and this error goes directly into the medical loss ratio. To recover funds most plans use inefficient processes and hire expensive collection agencies and lawyers. But our approach recovers more funds faster, and it eliminates an adversarial point of contention with your physician and hospital partners. The financial result is a better medical loss ratio and lower administrative costs. When you have a problem recovering overpayments, Nolan delivers.

Improving Return on Technology

Nolan thinks about technology like a profit center manager, not like a computer programmer. The reason you have millions of dollars in technology is to support your service process and interactions with clients, not the other way around. Our consultants know when and how to design a service process to get the most from new or old technology. We know when changing technology will help, and when it will add to your cost but not improve your service. We help clients define requirements, redesign processes, manage conversion projects and fix problems that emerge on the back-end of a system conversion. We have special expertise in retrofitting optical character recognition and image data capture technology on processing systems. And we have a wealth of experience in showing health plans how to use the World Wide Web as a service tool. When your technology should be more than a puzzle of hardware or software challenges, Nolan delivers.

Delivering Strategy with Impact

Nolan knows how difficult it is for executives and their staff to take a strategy and make it a reality. We have specific methodologies and programs to help executives achieve the potential of their plans. If you suspect that rope courses and team building aren't the best way to convert strategy to result, you may be ready to work with Nolan. We help you and your team do a better job with the work of management: planning; directing activities; budgeting of people, time and money; and measuring results against your strategy. When your strategy needs impact, Nolan delivers.

Experience Combined with Expertise